肝脏良恶性肿瘤行腹腔镜解剖性肝左外叶切除术的初步经验

目的 初步总结肝脏良恶性肿瘤行腹腔镜解剖性肝左外叶切除的安全性及疗效.方法 2005年4月至2008年5月共对11例肝脏良恶性肿瘤患者行腹腔镜下解剖性肝左外叶切除术(男性7例、女性4例,平均年龄51.7岁).其中原发性肝癌4例,伴不周程度肝硬化;结肠癌术后转移性肝癌1例;肝血管瘤5例(2例合并胆囊结石同时切除胆囊);巨大肝血平滑肌脂肪瘤1例.肿瘤最大径2.1～12.0 com,平均5.8cm,所有肿瘤均位于肝左外叶(Ⅱ、Ⅲ段).结果 手术时间为120～180 min,平均147 min.无中转开腹手术病例,无输血,无手术并发症.术后平均住院5.9 d.结论 对于位于Ⅱ、Ⅲ段的肝脏肿瘤施行腹腔镜下肝左外叶切除术是安全的.     

腹腔镜肝切除术的可行性

目的探讨腹腔镜肝切除手术的可行性. 方法 2002年7月～2004年2月行完全腹腔镜肝切除44例,其中原发性肝细胞癌22例、肝血管瘤10例、肝脓肿3例、肝囊肿伴感染1例、肝脏局灶结节性增生3例、肝脏腺瘤1例、胆管囊腺瘤1例、炎性肉芽肿1例、肝门部胆管癌1例、高分化胆管细胞癌1例.肝功能Child分级A级38例,B级6例(均为肝癌病人). 结果腹腔镜下完成肝局部切除17例、左肝规则性切除14例、右肝规则性切除13例.手术时间15～450 min,平均195 min.出血量50～1 500 ml,平均405 ml.输血量0～1 000 ml,平均175 ml.术后恢复顺利,术后住院2～9 d,平均5.6 d.结论腹腔镜肝切除术安全可行,不仅适于肝良性肿瘤,也为肝脏恶性肿瘤提供了切除肿瘤的新途径.     

腹腔镜肝癌切除术11例临床报告

目的　探讨腹腔镜肝癌切除手术的可行性与适应症。方法　 2 0 0 2年 7月～ 11月 ,经临床筛选病灶位于肝脏边缘、右肝表面或左半肝的病例 11例 ,HBs Ag(+ ) 7例 ,HCVAb(+ ) 2例 ,有肝硬变者 10例 ,肝功能 Child分级 A级 6例、B级 5例 ,AFP(+ ) 4例。病灶直径大小 1.8～ 6.0 cm,平均 3 .8± 1.7cm。对于肿瘤位于左半肝实质中的肿瘤 ,选行规则性左肝切除 ;对于肿瘤位于肝脏边缘或右肝表面时 ,选用肝脏局部切除术。结果　全部 11例均成功地在完全腹腔镜下完成肝切除术 ,切除范围包括局部切除 7例 ,左肝解剖性切除 4例 ,左半肝切除 1例、左外叶切除 2例、肝方叶切除 1例。全部肿瘤完整切除 ,肿瘤包膜完整 ,无破裂。手术时间 90～ 3 2 0分钟 ,平均 2 10 .9± 71.9分钟 ,出血量 5 0～ 10 0 0 ml,平均 4 4 3 .6± 3 3 0 .5 m l。切除肝体积最大 12 cm× 8cm× 6cm3、最小 3 cm× 3 cm× 2 cm。术中未出现不能控制的并发症 ,腹腔引流管放置时间 2～ 4天。术后未发生胆漏和出血等并发症 ,术后恢复顺利 ,术后平均住院 6.4天。结论　本组研究表明腹腔镜肝癌切除术是安全可行的 ,腹腔镜肝切除的适应证可适当放宽至右肝表面或左半肝的肝癌的首选的术式     

腹腔镜肝切除治疗肝脏肿瘤15例临床分析

目的 探讨完全腹腔镜肝切除治疗肝脏肿瘤的安伞性及有效性.方法 不阻断肝脏血流的情况下,联合采用超声刀、Ligasure及血管夹进行完伞腹腔镜下肝切除15例,其中肝海绵状血管瘤9例,直径5.0～15.0 cm(平均直径7.9 cm),肝囊肿纤维化3例,其中2例为引流术后复发,均位于左外叶,左外叶明显缩小.原发件肝癌3例,直径1.0～5.0 cm,肝功能均为Child A级.结果 15例患者腹腔镜肝切除均获成功,其中左外叶切除6例,其余患者为肝不规则切除,无中转手术.平均手术时间110 min,术中出血虽30～500 ml,平均251 ml.术后平均住院时间6.5 d,无术后死亡,术后除1例患者肝癌创面渗血,保守治愈外,其余无并发症,全部治愈.结论 对位于Ⅱ、Ⅲ、Ⅳa、Ⅴ、Ⅵ段肝脏肿瘤患者,采用完全腹腔镜肝切除是一种安全有效的微创治疗方法.     

巨大肝脏肿瘤266例切除的经验

目的 总结巨大肝脏肿瘤肝切除术的经验.方法 回顾性分析解放军总医院1986-2005年间266例连续性巨大肝脏肿瘤切除手术病例.结果 本组266例患者中男174例,女92例,年龄7～76岁,平均年龄(44.8±12.2)岁;其中良性肿瘤93例,以肝血管瘤最为常见,共80例(86.0%),最大直径30 cm;恶性肿瘤173例,最大直径33 cm,其中肝细胞癌(HCC)127例(73.4%).肿瘤平均直径(14.7±4.0)cm(10.2～33.0 cm).乙型肝炎病毒表而抗原阳性病例占40.49%.良性肿瘤患者平均切除(3.3±1.2)个肝段,恶性肿瘤患者平均切除(3.1±1.2)个肝段,二者比较差异无统计学意义(t=1.710,P=0.310).围手术期发生手术并发症46例,占17.29%.住院期间死亡2例,占0.75%.恶性肿瘤术后1、3、5年的累积牛存率分别为58.3%、39.7%及27.5%.结论 肝外科技术的成熟和围手术期处理的进步,使巨大肝肿瘤切除术保持低并发症发生率和低死亡率.     

腹腔镜肝切除术11例临床报告

目的:探讨腹腔镜肝切除术的适应证和可行性。方法:回顾分析10例病灶位于肝脏边缘及左肝外叶(Ⅱ～Ⅵ段)及1例位于Ⅷ段的肝占位患者的临床资料。其中原发性肝细胞癌8例,肝海绵状血管瘤2例,胆管细胞癌1例,肝功能Child-Pugh评分A级9例,B级2例;AFP(+)7例;位于左肝外叶实质中的肿瘤,行规则性左肝外叶切除;位于肝脏边缘或右肝表面的肿瘤,行肝脏局部切除。结果:11例均成功完成腹腔镜肝切除术,无中转开腹。其中局部切除术7例,左肝外叶切除术4例,腹腔镜脾切除+胆囊切除术2例。平均手术时间105min,术中平均出血220ml,切除病灶最大直径10cm。全部肿瘤均完整切除,肿瘤包膜完整,无破裂。术后未发生胆漏和出血等并发症,恢复良好,术后平均住院8.5d。结论:位于肝脏边缘、右肝表面或左半肝(Ⅱ～Ⅵ段)的肝脏占位,行腹腔镜肝切除术是安全可行的。     

后腹腔镜手术切除巨大肾上腺肿瘤

目的:探讨后腹腔镜手术切除巨大(直径≥6 cm)肾上腺肿瘤的可行性.方法:对15例巨大肾上腺肿瘤患者进行后腹腔镜切除手术,左侧9例,右侧6例,肿瘤大小6 cm×4 cm×3 cm～11 cm×9 cm×9 cm,平均7.3 cm×6.2 cm×4.8 cm.结果:11例成功行后腹腔镜手术切除,中转开放手术4例.术后2～3 d拔除伤口引流管,3～5 d下床活动,恢复顺利,无并发症.术后1～5年患者随访未发现异常.病理报告肾上腺囊肿3例,嗜铬细胞瘤3例,神经节瘤4例,皮质癌2例,神经鞘瘤1例,髓性脂肪瘤1例,肾上腺血肿1例.结论:巨大肾上腺肿瘤可以行后腹腔镜手术切除,但应在具有熟练的腹腔镜操作技术的条件下逐步开展.     

腹腔镜胆总管囊肿切除、肝管空肠Roux-Y吻合术治疗婴幼儿胆总管囊肿

目的 探讨腹腔镜下治疗婴幼儿胆总管囊肿的关键技术,介绍加用外固定肝脏拉钩应用的初步经验.方法 患儿42例,采用四Trocar加外置Nathanson肝脏拉钩外固定技术,腹腔镜下完成胆总管囊肿切除、肝总管空肠Roux-Y吻合胆道重建术.结果 本组患儿手术全部成功,无死亡,无中转开腹手术.手术平均时间为4.5h(3.5～7h),出血量10～50ml;术中发现合并美克尔憩室1例,肠旋转不良1例;切除阑尾5例;术后应激性溃疡并消化道出血2例,胆漏2例,胰漏1例,脐部伤口感染1例;术后平均住院时间6.5d(6～21d).术后随访1个月～5.5年,未发现胆囊炎、肠粘连梗阻和吻合口狭窄发生.结论 经腹腔镜行先天性胆总管囊肿切除、肝总管空肠Roux-Y吻合术是一种安全可靠的方法,腹腔镜下打结缝合技术和清晰宽敞的手术空间是该手术成功的关键与保障.     

肝脏囊性病变外科治疗的回顾性分析

目的　提高肝脏囊性病变 (囊肿≥ 4cm )的外科治疗水平。方法　对 1983～ 2 0 0 3年我院外科治疗肝脏囊性病变的病因、外科治疗方式及预后进行回顾性分析。结果　本组肝脏囊性病变病人 64例 ,其中单纯性肝囊肿 5 7例 ,肝棘球蚴病 4例 ,肝胆管囊腺瘤 2例 ,肝胆管囊腺癌 1例。囊肿平均直径为 10 .4cm。 16例单纯性肝囊肿行经皮囊肿穿刺抽液术 ,术后所有病人囊肿复发。 5 2例单纯性肝囊肿病人施行了手术治疗 ,其中 2 8例剖腹行囊肿去顶术 ,6例术后复发 ;18例腹腔镜辅助下手术 ,2例术后复发 ;囊肿切除术 2例 ,肝叶或肝部分切除术 4例。 4例肝棘球蚴病行包虫囊肿内囊摘除术 ,无复发。 2例肝胆管囊腺瘤和 1例肝胆管囊腺癌 ,均行肝叶切除术。结论　巨大 (≥ 4cm)、有临床症状的单纯性肝囊肿行经皮囊肿穿刺抽液术均复发 ;囊肿去顶术复发率低 ,腹腔镜辅助下手术较剖腹手术创伤小。肝棘球蚴病行包虫囊肿内囊摘除术是有效的 ,复发率低。肝胆管囊腺瘤可能恶变 ,应早期手术切除。     

完全腹腔镜肝切除时出血问题的探讨

目的　探讨腹腔镜肝切除手术的出血原因和预防措施。　方法　 2 1例中包括原发性肝癌 13例、肝血管瘤 3例、肝脓肿 2例、肝囊肿伴感染、局灶结节性增生、肝脏腺瘤各 1例。肝功能Child分级 :A级 16例 ,B级 5例 (均为肝癌病人 )。　结果　 2 1例在全气腹条件下完成腹腔镜肝切除手术 ,包括肝局部切除 12例 ,左肝解剖性切除 9例。手术时间 80～ 32 0 (平均 193 8± 78 3)min ,出血量 10 0～ 10 0 0ml (平均 333 1± 2 91 4 )ml,有 2例出血 10 0 0ml,术中输血各 80 0ml。术后恢复顺利 ,术后平均住院时间 6 3± 1 5d ,术后恢复时间较常规开腹方法肝切除患者明显缩短。　结论　本组研究表明在现有的手术器械条件和不阻断肝门血流的情况下 ,可以安全方便地处理术中出血。腹腔镜肝切除微创手术的前景广阔 ,不仅适于对肝良性肿瘤的手术 ,也为肝脏恶性肿瘤患者提供了切除肿瘤的新途径     

Laparoscopic management of benign solid and cystic lesions of the liver

OBJECTIVE: The authors present their experience in the laparoscopic management of benign liver disease. The aim of the study is to analyze technical feasibility and evaluate immediate and long-term outcome. SUMMARY BACKGROUND DATA: Indications for the laparoscopic management of varied abdominal conditions have evolved. Although the minimally invasive treatment of liver cysts has been reported, the laparoscopic approach to other liver lesions remains undefined. METHODS: Between September 1990 and October 1997, 43 patients underwent laparoscopic liver surgery. There were two groups of benign lesions: cysts (n = 31) and solid tumors (n = 12). Indications were solitary giant liver cysts (n = 16), polycystic liver disease (n = 9), hydatid cyst (n = 6), focal nodular hyperplasia (n = 3), and adenoma (n = 9). Only solid tumors, hydatid cysts, and patients with polycystic disease and large dominant cysts located in anterior liver segments were included. All giant solitary liver cysts were considered for laparoscopy. Patients with cholangitis, cirrhosis, and significant cardiac disease were excluded. Data were collected prospectively. RESULTS: The procedures were completed laparoscopically in 40 patients. Median size was 4 cm for solid nodules and 14 cm for solitary liver cysts. Conversion occurred in three patients (7%), for bleeding (n = 2) and impingement of a solid tumor on the inferior vena cava (n = 1). The median operative time was 179 minutes. All solitary liver cysts were fenestrated in less than 1 hour. There were no deaths. Complications occurred in 6 cases (14.1%). Two hemorrhagic and two infectious complications were noted after management of hydatid cysts. There were no complications after resection of solid tumors. Three patients received transfusions (7%). The median length of stay was 4.7 days. Median follow-up was 30 months. There was no recurrence of solitary liver or hydatid cysts. One patient with polycystic disease had symptomatic recurrent cysts at 6 months requiring laparotomy. CONCLUSION: Laparoscopic liver surgery can be accomplished safely in selected patients with small benign solid tumors located in the anterior liver segments and giant solitary cysts. The laparoscopic management of polycystic liver disease should be reserved for patients with a limited number of large, anteriorly located cysts. Hydatid disease is best treated through an open approach.     

Laparoscopic treatment of solid and cystic tumors of the liver. Study of 33 cases

AIM OF THE STUDY: Laparoscopic liver surgery is still in its early stages. The aim of this study was to report our experience in the laparoscopic management of solid and cystic liver tumours. PATIENTS AND METHODS: From April 1991 to December 1999, 32 patients with various lesions of the liver underwent laparoscopic liver surgery. One group of patients presented with cysts (n = 15) (11 giant solitary cysts and 4 polycystic liver diseases) and one group of patients presented with solid tumours (n = 18): focal nodular hyperplasia (n = 8), haemangioma (n = 6), adenoma (n = 2), isolated metastasis from a colonic cancer (n = 1) and hepatocellular carcinoma (n = 1). Fifteen cyst fenestrations and eighteen liver resections were performed via a laparoscopic approach including 1 right lobectomy, 5 left lateral segmentectomies, 2 subsegmentectomies IVb, 1 segmentectomy III and 9 non-anatomical resections. RESULTS: Conversion to laparotomy was performed in one case (3%) at the end of the operation (patient who had successfully undergone left lateral segmentectomy for hepatocellular carcinoma) to check the resection margins and surgical transection had been performed in healthy parenchyma. Mean diameter of solid tumours was 6.5 cm and 15.7 cm for solitary cysts. The mean operating time for hepatic resections was 232 minutes. There was no postoperative mortality. Complications occurred in one case for each group and consisted in intestinal stricture through a port site requiring intestinal resection. Mean postoperative hospital stay was 5.6 days for solid tumours and 7.5 days for cystic lesions. In the group of cystic lesions, the recurrence rate was 50% with a 5.5-months follow-up. CONCLUSION: Laparoscopic liver surgery can be safely performed, but requires a good experience in open hepatic surgery and laparoscopic surgery. The laparoscopic approach is indicated in patients with symptomatic or atypical benign solid tumour, giant solitary cyst and polycystic liver disease, located anteriorly on the liver. Indications for malignant lesions have not been clearly defined and require further information.     

Technical considerations in laparoscopic liver surgery

BACKGROUND: Laparoscopic solid organ surgery has gained growing acceptance, but this does not hold for laparoscopic surgery of the liver. Laparoscopic liver surgery mainly comprizes diagnostic procedures and treatment of liver cysts. However, we believe there is room for a laparoscopic approach to the liver in selected cases, with the benefits that may be expected from laparoscopic solid organ surgery. METHODS: Between 1993 and 2000, 10 patients with various lesions of the liver underwent laparoscopic surgery. Indications consisted of cystic disease (n = 2), hemangioma (n = 2), focal nodular hyperplasia (n = 2), liver abcess (n = 1), and liver metastasis (n = 3). Laparoscopic treatment varied from fenestration (n = 3) to wedge resections (n = 5), and formal left lateral hepatectomy (n = 2). RESULTS: The mean patient age was 54 years (range, 34-71 years). The mean operative time, including laparoscopic ultrasonography, measured 180 min (range, 80-240 min). Peroperative blood loss ranged from 200 to 450 ml. There was no mortality. In two patients, conversion to laparotomy was necessary. There were no postoperative complications. The mean hospital stay was 6 days (range, 4-11 days). CONCLUSION: Laparoscopic treatment should be considered in selected patients with benign and malignant lesions in the left lobe or frontal segments of the liver.     

Laparoscopic procedures in focal lesions of the liver

Seventy-three laparoscopic procedures were performed for the treatment of focal lesions of the liver. Fifty-four patients had operations for non-parasitic cysts of the liver and cystic disease. Polycystic disease of the liver was in 8 patients. Multiple cysts were in 19 patients, solitary - in 27. A total of 139 cysts were treated. Surgery was performed with the standard technique. Atypical marginal resection of the liver was performed in 16 patients for hemangioma (n=8), nodular hyperplasia (n=2), hepatic metastases (n=5), hamartoma (n=1). Atypical marginal resection by type of peritumor resection was conducted in 5 cases, and it was similar to segmentectomy in 11 cases. Laparoscopic cryodestruction of benign tumors and hepatic metastases was performed in 3 patients including in combination with atypical marginal resection in 2 cases. There were no intrasurgical complications which required laparotomies. There were no hemotransfusions. Long-term results were followed-up from 1 to 3 years in 25 patients with hepatic cysts and from 3 months to 3 years in 7 patients after marginal resection for hemangiomas and fibronodular hyperplasia. Ultrasonic examination revealed no recurrences of the disease.     

Laparoscopic liver resection of benign liver tumors

Objective: The objective of this study was to assess the feasibility, safety, and outcome of laparoscopic liver resection for benign liver tumors in a multicenter setting. Background: Despite restrictive, tailored indications for resection in benign liver tumors, an increasing number of articles have been published concerning laparoscopic liver resection of these tumors. Methods: A retrospective study was performed in 18 surgical centres in Europe regarding their experience with laparoscopic resection of benign liver tumors. Detailed standardized questionnaires were used that focused on patient's characteristics, clinical data, type and characteristics of the tumor, technical details of the operation, and early and late clinical outcome. Results: From March 1992 to September 2000, 87 patients suffering from benign liver tumor were included in this study: 48 patients with focal nodular hyperplasia (55%), 17 patients with liver cell adenoma (21%), 13 patients with hemangioma (15%), 3 patients with hamartoma (3%), 3 patients with hydatid liver cysts (3%), 2 patients with adult polycystic liver disease (APLD) (2%), and 1 patient with liver cystadenoma (1%). The mean size of the tumor was 6 cm, and 95% of the tumors were located in the left liver lobe or in the anterior segments of the right liver. Liver procedures included 38 wedge resections, 25 segmentectomies, 21 bisegmentectomies (including 20 left lateral segmentectomies), and 3 major hepatectomies. There were 9 conversions to an open approach (10%) due to bleeding in 45% of the patients. Five patients (6%) received autologous blood transfusion. There was no postoperative mortality, and the postoperative complication rate was low (5%). The mean postoperative hospital stay was 5 days (range, 2–13 days). At a mean follow-up of 13 months (median, 10 months; range, 2–58 months), all patients are alive without disease recurrence, except for the 2 patients with APLD. Conclusions: Laparoscopic resection of benign liver tumors is feasible and safe for selected patients with small tumors located in the left lateral segments or in the anterior segments of the right liver. Despite the use of a laparoscopic approach, selective indications for resection of benign liver tumors should remain unchanged. When performed by expert liver and laparoscopic surgeons in selected patients and tumors, laparoscopic resection of benign liver tumor is a promising technique.     

Laparoscopic management of benign liver disease

Minimally invasive techniques may be used for treating a variety of benign hepatic lesions in selected patients. The size of the lesions is less important than the anatomic location in anterolateral regions. Laparoscopic unroofing of solitary liver cysts is the surgery of choice for this indication. The laparoscopic management of patients with PLD should be reserved for patients with a few, large, anteriorly located, symptomatic cysts. Active hydatid cysts present technical difficulties because of their complex biliovascular connections and the inherent nature of the parasite. The authors' results do not support the widespread use of laparoscopy in these cases. Uncomplicated benign liver tumors located in the left lobe or in the anterior segments of the right lobe can be resected safely using a four-hand technique. Open surgery is the treatment of choice when primary tumors are malignant, located posteriorly, or in proximity to major hepatic vasculature. Laparoscopic resection of liver metastases with a safety margin of 1 cm, when the total number is less than four, is not unreasonable and can be offered to patients without evidence of extrahepatic disease.     

Possibilities of laparoscopic liver resection

The aim of this study was to report the results of our experience in liver surgery by laparoscopy. From 1989 to 1996, 30 patients (20 women, 10 men; age, 23–88 years; mean age, 53.9 years) underwent laparoscopic liver surgery at our Institute for the following pathology: 10 for biliary cysts, 7 for polycystic diseases, 8 for benign tumors, 3 for hydatid cysts, 1 for chronic abscess, and 1 for metastasis. The locations of these lesions were: 19 in the left lobe, 4 in the right lobe, and 7 in both lobes. Their average size was 8.45 cm (range, 2.5–22 cm). The largest lesions were biliary cysts; among benign tumors, the maximum diameter was 8 cm. Surgical treatment was as follows: 17 deroofings, 3 pericystectomies, 7 tumorectomies, and 3 left lobectomies. The mean operative time was 79 min (range, 45–527 min). Three of the 30 laparoscopic procedures (10%) were converted to open surgery, because of bleeding in 2 patients with polycystic disease and because it was impossible to carry out the dissection in 1 patient with liver-cell adenoma adjacent to the left portal branch. There were no deaths in this series and 6 patients showed morbidity: 2 patients with polycystic disease developed ascites and required intensive care unit recovery, 1 patient had phlebitis, 1 had infection of the urinary tract, and 2 had local septic complications. Preliminary findings show that the laparoscopic approach to liver lesions may represent safe and effective treatment in selected patients, on condition that several technical details are respected. Of fundamental importance are the surgical equipment, the presence of two experienced operators to do four-hands surgery, and the careful selection of indications, reserving laparoscopic treatment only for those lesions located in easily accessible areas, mainly in the lateral and anterior hepatic segments. Received for publication on Aug. 21, 1999; accepted on Sept. 2, 1999     

Laparoscopic resection of gastric stromal tumor: a tailored approach

Many different laparoscopic approaches to resection of gastric stromal tumor have been described in the literature. We reviewed our experience of laparoscopic approaches to surgical resection of gastric stromal tumors seven in six consecutive patients. The tumor locations were the gastric cardia (n = 2), gastroesophageal junction (n = 1), gastric fundus (n = 2), and gastric antrum (n = 2). Laparoscopic localization of endoluminal tumors included intraoperative endoscopy, laparoscopic ultrasound, and laparoscopic palpation. There were five males with a mean age of 57 years. Laparoscopic approaches to resection were laparoscopic wedge resection (n = 4) for tumors in the gastric fundus and antrum, laparoscopic enucleation (n = 2) for tumors in the gastric cardia, and transgastric endoluminal resection (n = 1) for a tumor located at the gastroesophageal junction. There was no conversion to laparotomy. The mean operative time was 143 +/- 54 minutes and mean blood loss was 57 +/- 27 mL. None of the patients required intensive care stay. The mean length of hospital stay was 3 days. There were no major or minor complications and no mortality. Surgical pathology demonstrated gastric stromal tumor with less than 2/50 mitosis per high power field in all seven specimens. Tumor size ranged from 2.8 cm to 7.1 cm in greatest diameter. There has been no tumor recurrence with a mean follow-up of 9 months. Laparoscopic resection of benign gastric stromal tumor is safe and feasible. The laparoscopic approaches to surgical resection should be tailored based on the location and characteristics of the tumor.     

Laparoscopic management of benign cystic lesions of the liver

We present our experience in the laparoscopic management of benign liver cysts. The aim of the study was to analyze the technical feasibility of such management and to evaluate safety and outcome on follow-up. Between September 1990 and October 1997, 31 patients underwent laparoscopic liver surgery for benign cystic lesions. Indications were: solitary giant liver cysts (n = 16); polycystic liver disease (PLD; n = 9); and hydatid cysts (n = 6). All giant solitary liver cysts were considered for laparoscopy. Only patients with PLD and large dominant cysts located in anterior liver segments, and patients with large hydatid cysts, regardless of segment or small partially calcified cysts in a safe laparoscopic segment, were included. Patients with cholangitis, cirrhosis, and significant cardiac disease were excluded. Data were collected prospectively. The procedures were completed laparoscopically in 29 patients. The median size of the solitary liver cysts was 14 cm (range, 7–22 cm). Conversion to laparotomy occurred in 2 patients (6.4%), to control bleeding. The median operative time was 141 min (range, 94–165 min) for patients with PLD and 179 min (range, 88–211 min) for patients with hydatid cysts. All solitary liver cysts were fenestrated in less than 1 h. There were no deaths. Complications occurred in 6 patients (19%). Two hemorrhagic and two infectious complications were noted after management of hydatid cysts. Three patients were transfused. The median length of hospital stay was 1.3 days (range, 1–3 days), 3 days (range, 2–7 days), and 5 days (range, 2–17 days) for solitary cyst, PLD, and hydatid cysts, respectively. Median follow-up was 30 months (range, 3–78 months). There was no recurrence of solitary liver cyst or hydatid cysts. One patient with PLD presented with symptomatic recurrent cysts at 6 months, requiring laparotomy. We conclude that laparoscopic liver surgery can be accomplished safely in patients with giant solitary cysts, regardless of location. The laparoscopic management of polycystic liver disease should be reserved for patients with a limited number of large, anteriorly located cysts. Hydatid disease is best treated through an open approach. Received for publication on Aug. 21, 1999; accepted on Sept. 2, 1999     

Laparoscopic hepatic resection

Background Although laparoscopy in general surgery is increasingly being performed, only recently has liver surgery been performed with laparoscopy. We critically review our experience with laparoscopic liver resections. Methods From January 2000 to April 2004, we performed laparoscopic hepatic resection in 16 patients with 18 hepatic lesions. Nine lesions were benign in seven patients (five hydatid cysts, three hemangiomas, and one simple cyst), five were malignant in five patients (five hepatocarcinoma), and four patients had an uncertain preoperative diagnosis (one suspected hemangioma and three suspected adenomas). The mean lesion size was 5.2 cm (range, 1–12). Twelve lesions were located in the left lobe, three were in segment VI, one was in segment V, one was in segment IV, and one was in the subcapsular part of segment VIII. Results The conversion rate was 6.2%; intraoperative bleeding requiring blood transfusions occurred in two patients. Mean operative time was 120 min. Mean hospital stay was 4 days (range, 2–7). There were no major postoperative complications and no mortality. Conclusions Hepatic resection with laparoscopy is feasible in malignant and benign hepatic lesions located in the left lobe and anterior inferior right lobe segments (IV, V, and VI). Results are similar to those of the open surgical technique in carefully selected cases, although studies with large numbers of patients are necessary to drawn definite conclusions.